Pathology/Lab Coding Alert

Question: When a physician orders a Pap smear more frequently than Medicare allows as a follow-up to a patient's abnormal Pap result, what diagnosis code should we use V15.89? In this case, will Medicare cover the Pap test more often than the usual once every two years?

Ohio Subscriber

Answer: Medicare's frequency rules for Pap smears apply only to screening tests given in the absence of signs and symptoms of disease. Since you are asking about a Pap smear for a patient who had an abnormal initial test, Medicare considers the test diagnostic, and the frequency rules don't apply. The Pap smear in this case should be covered more often than once every two years.

The correct ICD-9 code for a repeat Pap smear due to abnormal results depends on the original abnormal findings. If the original Pap showed dysplasia, for example, report 622.1 for cervical intraepithelial neoplasia (CIN) I or II, or 233.1 for CIN III. If the ordering physician only reports abnormal Pap as the reason for the test, and the lab doesn't have the specific cytology results from the initial screening, report a nonspecific code such as 795.00 (Nonspecific abnormal Papanicolaou smear of the cervix, unspecified).

If the patient has a known history of a condition, such as human Papillomavirus (HPV), report that condition as well (e.g., V13.2, Personal history of other genital system and obstetric disorders). Based on a previous abnormal Pap, you would not report V15.89 (Other specified personal history presenting hazards to health, other), which Medicare uses as the reason for screening tests for patients at high risk for cervical cancer.

Medicare covers a screening Pap smear for asymptomatic, low-risk women once every two years, reported with V76.2 (Special screening for malignant neoplasms, cervix). For high-risk women of childbearing age, Medicare covers the test once each year, reported with V15.89. Patients at high risk for cervical cancer are those with any of the following histories: early onset of sexual activity, multiple sexual partners, history of sexually transmitted disease, having fewer than three negative Pap smears within seven years, or being the daughter of a woman who took DES (diethylstilbestrol) during pregnancy.